Earlier this month trust chief executive Peter Coles warned there were tough times ahead as the trust announced it had to save more than £34 million this year.

The trust has already earmarked savings of about £15 million and is confident of securing a loan of £10 million from Surrey and Sussex Strategic Health Authority but substantial savings will still have to be made.

The man in charge of the hospital's finances, David Dumigan, agrees there are some difficult times ahead and warns action needs to be taken now to stop the problem getting worse.

Brighton and Sussex is not alone in having money worries, as trusts across the country are reporting deficits and struggling to keep their heads above water.

In Sussex alone, the Royal West Sussex NHS Trust, which runs St Richard's Hospital, and Surrey and Sussex Healthcare NHS Trust, which runs Crawley Hospital, are both millions of pounds in the red.

St Richard's Hospital had an independent report of its finances prepared by auditor PriceWaterhouseCooper which said the crisis was getting so bad the trust might not be able to pay its creditors without help.

Brighton and Sussex has not reached that point but it could unless it starts tightening its belt.

This could mean job losses and a freeze on recruiting more staff.

Mr Dumigan said: "At this stage we are not looking at redundancies but are concentrating on those posts which have been vacant for a while.

"We are also looking to reduce the number of bank and agency staff we use to fill posts as they are more expensive."

Changes will also lead to more patients being seen as day patients rather than staying in hospital, and reducing the number of in-patients.

Mr Dumigan insisted this would not affect patient care.

He said: "Treating more patients as day patients is being done everywhere. Most patients prefer to be back at home rather than in hospital.

"A large amount of money is also being invested, providing more treatment and support for patients in the community and through their GPs and in their own homes.

"We have to make the hospital run smoothly and be more efficient financially.

"That means not doubling up posts where they are not necessary and ensuring that when patients are in hospital they are seen and treated quickly."

Brighton and Sussex is the largest trust in the county and one of the busiest, dealing with an immediate local population of 500,000 and providing a country-wide service to 1.5 million for heart, kidney and cancer services.

So why is it struggling so much financially?

There are several elements to consider.

As a public body the trust must, by law, make a two per cent saving every year. This rule applies to all public organisations including fire and police authorities.

It is also more expensive to run than an average hospital.

Mr Dumigan says this is partly because of the length of time some patients are staying in hospital because they are waiting for a care or nursing home place.

It costs about £300 a day to keep a patient in a hospital bed, which is much more expensive than a nursing or care home.

This is partly why the trust will no longer be using wards at Brighton General Hospital from July 18.

Instead patients will either be treated at the Royal Sussex or given support in the community. This could be through a visit from a nurse, physiotherapist or other healthcare worker.

Mr Dumigan said treating patients as day cases also worked out cheaper.

He said: "For example, we are looking at treating patients coming in for a cataract operation as a day case.

"They can be seen in the morning, have their treatment done and then go home at the end of the day.

"It is a relatively straightforward operation and in most cases a patient wouldn't need to stay in.

"That means the medical patients who do need the care and have to stay in can be seen and treated more quickly.

"I keep saying it but we do need to run more efficiently.

"We always have to take into account that we are dealing with people here and looking after them. That must be the main priority. But we have to spend tax payers money wisely and carefully. Every penny must be accounted for."

The hospital's financial problems seem to have become worse over the last few years.

Mr Dumigan says it is because it has been growing and developing over the years and doing more treatments and operations.

He said: "We are getting top surgeons who are willing to push back boundaries and treat people and this all costs more.

"Society is getting older and doctors are doing whatever they can to prolong life and improve the quality of that life.

"This is particularly so in cancer care, which uses extremely expensive drugs and it is the same with HIV/Aids patients. Obviously this is an important element of patient care and needs to continue.

"We also have the specialist renal unit, cardiac centre, cancer centre and are constantly trying to do more than we have ever done before."

Last year the trust overspent about £7.7 million which is about 2.6 per cent of the whole budget.

This is equivalent to someone on a salary of £22,500 having an overdraft of £600.

The trust is spending £820,000 a day and £34,000 every hour a year.

Mr Dumigan said every year it was a struggle to keep the hospital's books balanced so he needed to ensure he got the best patient care out of every pound available.

He said: "Every year you are working to land a jumbo jet on a postage stamp. You need to be exactly on target.

"If you're too short you've not spent enough and if you're too long you've spent too much. It is a real balancing act."